Ambulatory monitoring of patients with COVID-19: initial experiences and next steps

Connolly, Stephen P; Katolo, Henriette Wa; Cronin, Colm; Dingle, Alison; Creed, M; Edwards, Colin; O’Reilly, Katherine Ma; O’Kelly, Brendan; Lambert, John S; Muldoon, Eavan G.; Sheehan, Gerard; Coetzee, Heather; Sharp, Alan; Dempsey, Suzanne; O’Connor, Eileen; Farrell, Jeremy; Cotter, Aoife G.; McGinty, Tara

doi:10.1136/bmjinnov-2021-000875

Cited by 5 publications

(2 citation statements)

References 7 publications

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“…The usefulness of the DystoniaDiary app would be improved if the patient-recorded information was made available to their clinical care centers in real time (via a browser-based portal) to monitor treatment effectiveness and potentially adjust treatment schedules. This approach has been widely adopted in monitoring respiratory diseases, including COVID-19 [ 9 ], interstitial lung disease [ 10 ], and post–lung transplantation care [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

A Bespoke Electronic Health Journal for Monitoring Response to Botulinum Toxin in Treatment of Cervical Dystonia: Open-Label Observational Study of User Experience

Edwards¹,

Borton²,

Ross³

et al. 2023

JMIR Form Res

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Background The mainstay of treatment for cervical dystonia (CD) is regular botulinum toxin injections every 3-4 months. Clinical evaluation of response is dependent on the patient’s recall of how well symptoms responded to the previous injection. A mobile health app could assist both patients and health care professionals to monitor treatment benefits and side effects to assist with the selection of muscle and toxin dose to be injected at the next visit. The DystoniaDiary is a bespoke electronic health journal for monitoring symptoms of CD and response to treatment. Objective The objective of this study was to assess the acceptability and utility of the DystoniaDiary in patients with CD treated with botulinum toxins as part of their usual care. Methods In this open-label, single-center, single-arm observational study, patients attending a botulinum toxin injection clinic were invited to download the DystoniaDiary app. Patients selected up to 3 of their most troublesome CD symptoms (from a predefined list) and were prompted every 3 days to rate the control of these symptoms on a scale from 0 (very badly) to 100 (very well). Dates of onset and wearing off of response to injected botulinum toxin and responses to the Cervical Dystonia Impact Profile (CDIP-58) questionnaire at baseline and week 6 were also recorded in the app. Results A total of 34 patients installed DystoniaDiary. Twenty-five patients (25/34, 74%) recorded data for ≥12 weeks and 21 patients (21/34, 62%) for ≥16 weeks. Median time between the first and last data input was 140 days with a median of 13 recordings per patient. User experience questionnaires at weeks 4 and 12 (20 respondents) indicated that the majority of respondents found the DystoniaDiary app easy to install and use, liked using it, would recommend it to others (19/20), and wished to continue using it (16/20). A smaller proportion indicated that the DystoniaDiary gave a greater sense of control in managing their CD (13/20). There was interindividual variation in patients’ perceptions of control of their symptoms after botulinum toxin injection. Response to treatment was apparent in the symptom control scores for some patients, whereas the severity of other patients’ symptoms did not appear to change after treatment. Conclusions This observational study demonstrated that the DystoniaDiary app was perceived as useful and acceptable for a large proportion of this sample of patients with CD attending a botulinum toxin clinic. Patients with CD appear to be willing to regularly record symptom severity for at least the duration of a botulinum injection treatment cycle (12-16 weeks). This app may be useful in monitoring and optimizing individual patient responses to botulinum toxin injection.

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Section: Discussionmentioning

confidence: 99%

A Bespoke Electronic Health Journal for Monitoring Response to Botulinum Toxin in Treatment of Cervical Dystonia: Open-Label Observational Study of User Experience

Edwards¹,

Borton²,

Ross³

et al. 2023

JMIR Form Res

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“…The Mater Misericordiae University Hospital (MMUH) established a Post-COVID Clinic in June 2020 to follow up all patients who tested positive for SARS-CoV-2 on polymerase chain reaction (PCR) testing through hospital services during the first wave of the pandemic (between March 10 th and June 14 th 2020). The majority of these patients were tested and diagnosed through the hospital, did not meet criteria for admission, and were monitored remotely via a COVID virtual clinic (CVC) using SpO 2 readings, heart rate readings and dyspnoea scores [12]. The rest of the clinic cohort encompassed those that were admitted to hospital with COVID-19 and those with hospital acquired COVID-19.…”

Section: Clinic Backgroundmentioning

confidence: 99%

Post-COVID care delivery: The experience from an Irish tertiary centre’s post-COVID clinic

et al. 2023

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Background The long-term effects of SARS-CoV-2 infection and optimal follow-up approach are not well-recognised. Here we describe the implementation of a post-COVID clinic in an Irish tertiary centre after the first wave of the pandemic. This study describes the characteristics of our patient cohort and the operations and outcomes of the clinic, exploring some of the risk factors for developing post-COVID syndrome and the appropriateness of the triage system employed. Methods All SARS-CoV-2 positive patients from March 10th to June 14th 2020 were telephone-triaged as red, amber or green based on ongoing symptoms with clinic appointments scheduled accordingly. All clinic visits were face-to-face with the infectious diseases medical team and a proforma for each patient was completed. Data were collected retrospectively by reviewing the proformas and the electronic medical record (EMR). Results 311 patients attended the clinic. Median time from illness to clinic appointment was 95 days (IQR 77–105.5). 204 patients (66%) were female, 192 (62%) were hospital staff, and the median age was 43 years (IQR 31–53). 138 patients (44%) had required hospital admission. At their first clinic visit 219 patients (70%) had ongoing symptoms. A further appointment was made for 62 patients (20%). 34 patients (11%) were discussed at an MDT meeting, and 55 (18%) were referred onward to a specialist service. 85% of those triaged green, 73% of those triaged amber, and 39% of those triaged red did not receive further follow up after one clinic visit. Patients were more likely to require follow up with reported dyspnoea (OR 5.6; 95% CI 2.8–11.3; p <0.001), cough (OR 3.0; 95% CI 1.1–8.4, p = 0.04), and palpitations (OR 3.6; 95% CI 1.0–12.3; p = 0.04). Female sex was associated with increased odds of a higher triage category (OR 1.8; 95% CI 1.08 to 3.20; p = 0.02), as was requiring admission to hospital (OR 4.0; 95% CI 2.34 to 6.90; p < 0.001). Conclusion The long-term effects of COVID-19 are significant with 70% of our cohort experiencing persistent symptoms. Persistent dyspnoea, cough and palpitations were associated with increased need for follow up. This study also suggests that a traffic light telephone-triage service followed by a face-to-face medical-led clinic could be an effective way of identifying patients who require further management.

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Rapid implementation of home oxygen treatment and remote monitoring for COVID-19 patients at the verge of the Omicron wave in Turku, Finland

Hänninen,

Anttalainen,

Kilpeläinen

et al. 2023

BMC Infect Dis

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Background In Turku, Finland, we introduced a home oxygen treatment and app-based monitoring program for hospitalized COVID-19 patients to facilitate an early discharge during the Omicron wave. In this case series we explore the clinical parameters of patients enrolled in the program and evaluate the cost–benefit and safety issues of the program. Methods Hospitalized COVID-19 patients with marked hypoxemia but otherwise in stable condition were screened from Turku City Hospital and Turku University Hospital by treating doctors for eligibility in the program. Peripheral oxygen saturation of > 92% and breathing frequency < 30/min in rest with oxygen supplementation were among the criteria. All patients actively participating in the program between 10th of January 2022 and 30th of September 2022 were included in this case series. Clinical data of hospitalization and monitoring were analysed, and cost–benefit evaluation was based on the number of saved hospitalization days. Results Nineteen COVID-19 patients were included in this case series and recruited from three different hospital departments in the Turku city region, South-West Finland. All patients were male, the median age was 59 years and the median duration of hospitalization before enrolment in the program was 6 days (range 3—20 days). The median duration of home oxygen treatment was 13 days (range 3—72 days) and the median duration of home monitoring was 18 days (range 7—41 days). A total of 210,5 hospital days were prevented, resulting in savings of €144,490 of healthcare expenditure (on average 9 days and €7,605 per patient). No major safety issues were reported during the program. Conclusions In our case series, home oxygen treatment combined with home monitoring was safe and economically beneficial. Application based monitoring could be considered in other post-acute pulmonary conditions to reduce hospitalization and healthcare costs.

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Ambulatory monitoring of patients with COVID-19: initial experiences and next steps

Cited by 5 publications

References 7 publications

A Bespoke Electronic Health Journal for Monitoring Response to Botulinum Toxin in Treatment of Cervical Dystonia: Open-Label Observational Study of User Experience

A Bespoke Electronic Health Journal for Monitoring Response to Botulinum Toxin in Treatment of Cervical Dystonia: Open-Label Observational Study of User Experience

Post-COVID care delivery: The experience from an Irish tertiary centre’s post-COVID clinic

Rapid implementation of home oxygen treatment and remote monitoring for COVID-19 patients at the verge of the Omicron wave in Turku, Finland

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